Akut izoniazid intoksikasyonuna bağlı nöbet

Year 2018, , 361 - 364, 28.09.2018

Arife Erdoğan , Serdar Beden Mümin Alper Erdoğan Vermi Değerli İsmet Parlak

https://doi.org/10.31362/patd.451578

Abstract

İzoniazid (İNH) tüberküloz tedavisinde ve profilaksisinde yaygın olarak
kullanınlan bir antitüberküloz ilaçtır. Akut İNH zehirlenmesi, standart
antikonvülsanlara dirençli nöbetlere, sodyum bikarbonat tedavisine dirençli
yüksek anyon açıklı metabolik asidoza ve komaya neden olur. Alınan İNH dozuna
eş miktarda parenteral piridoksin verilmesi en etkili tedavidir. Tedavi
edilmemiş vakalar ölümle sonuçlanabilir. Biz akut İNH zehirlenmesi nedeniyle
jeneralize tonik klonik nöbete sekonder sol omuz dislokasyonu ve fraktürü
saptanan 24 yaşında bir kadın hasta olgusunu sunuyoruz. Senkop nedeniyle acil
servise başvuran hasta muayene sedyesine alınır alınmaz nöbet geçirdi, izlemde
bilinç bulanıklığı ve kan gazında metabolik asidoz saptandı. Klinik gözlem ve
semptomatik tedavi sonrası bilinci açılan hastanın tüberküloz deri tutulumu
için İNH kullandığı, akşam dozunu içtiğini unutarak tekrar içtiği tespit
edildi. Hasta 24 saat acil serviste monitorize olarak takip edildi. İzlemde
nöbet olmaması, başka ek semptomların gelişmemesi ve metabolik değerlerin
düzelmesi üzerine şifa ile taburcu edildi. Sonuç olarak durdurulamayan
nöbetlerle acil servislere başvuran hastalarda, metabolik asidoz ve koma
birlikteliğinde İNH zehirlenmesi de düşünülmeli ve acil servislerde parenteral
piridoksin mutlaka bulundurulmalıdır.

Keywords

İzoniazid zehirlenmesi, konvülziyon, metabolik asidoz

Secondary shoulder dislocation and fracture due to acute isoniazid intoxication.

Abstract

Isoniazid (INH) is an antituberculosis drug which is widely used in the
treatment and prophylaxis of tuberculosis. Acute INH intoxication leads to
resistive seizure to standard anticonvulsants, high anion-clear metabolic
acidosis resistant to sodium bicarbonate treatment and coma. Parenteral
pyridoxine administration in the same amount with INH dose is the most
effective treatment. We present a case of a 24-years-old woman who diagnosed
with left shoulder dislocation and fracture secondarily to generalized tonic
clonic seizure due to acute INH intoxication. The patient who was referred to
ED due to syncope had a seizure upon examination, loss of consciousness and
metabolic acidosis was also detected. It was learned that the patient who
restored to consciousness after treatment, had used INH for skin involvement of
tuberculosis and also recieved INH again mistakenly for nighttime dose. The
patient was monitored 24 hours and discharged with a cure upon there was no
seizure in monitoring, non-development of any other additional symptoms and
because of improvements in metabolic parameters. In conclusion, it should also
be considered to have intoxication of INH in patients who referred with
unstoppable seizures, metabolic acidosis and coma, thus parenteral pyridoxine
must definitely be provided in emergency departments.

Keywords

Isoniazid intoxication, convulsion, metabolic acidosis

References

• Kaynaklar 1. Romero JA, Kuczler FJ Jr. Isoniazid overdose: recognition and management. Am Fam Physician 1998;57:749-752.
• 2. Boyer EW. Antituberculous agents. In: Goldfrank L, Flomenbaum N, Lewin N, Howland MA, Hoffman R, Nelson L, Goldfrank’s toxicologic emergencies. 7th ed. New York: McGraw Hill, 2002;655-670.
• 3. Chalut D. Isoniazid. In: Erıckson TB, Ahrens AWR, Aks SE, Baum C, Ling L, ed. Pediatric toxicology. New York: McGraw Hill, Co, 2005;292-295.
• 4. Cakmak A, Atas A, Soran M, Zeyrek D. Acute isoniazid poisoning presenting with convulsions and coma. Harran Üniversitesi Tıp Fakültesi Dergisi 2009;6:47-48.
• 5. Gokhale YA, Vaidya MS, Mehta AD, Rathod NN. Isoniazid toxicity presenting as status epilepticus and severe metabolic acidosis. J Assoc Physicians India 2009;57:70-71.
• 6. Lheureux P, Penaloza A, Gris M. Pyridoxine in clinical toxicology: a review. Eur J Emerg Med 2005;12:78-85.
• 7. Tibussek D, Mayapetek E, Distalmaier F, Rosenbaum T. Status epilepticus due to attempted suicide with isoniazid. Eur J Pediatr 2006;165:136-137.
• 8. Osborn H. Antituberculous agents. In: Goldfrank LR, et al. ed. Goldfrank’s toxicologic emergencies. 6th ed. Norwalk, Conn: Appleton & Lange, 2004;627-635.
• 9. Agrawal RL, Dwivedi NC, Agrawal M, Jain S, Agrawal A. Accidental isoniazid poisoning-A report. Indian J Tuberc 2008;55:94-96.
• 10. Okutur SK, Borlu F, Ersoy ÇY, Paksoy F. Acute isoniazid intoxication: convulsion, rhabdomyolysis and metabolic acidosis. Turk J Med Sci 2006;36:397-399.
• 11. Erdman A. Isoniazid. In: Olson KR, ed. Poisoning, drug overdose. 4th ed. New York: McGraw Hill, Co, 2004;223-224.
• 12. LoVecchio F, Curry SC, Graeme KA, Wallace KL, Suchard J. Intravenous pyridoxine-induced metabolic acidosis. Ann Emerg Med 2001;38:62-64.
• 13. Topcu I, Yentur EA, Kefi A, Ekici NZ, Sakarya M. Seizures, metabolic acidosis and coma resulting from acute isoniazid intoxication. Anaesth Intensive Care 2005;33:518-520.
• 14. Ellenhorn MJ. Isoniazid. In: Ellenhorn MJ, Schonwald S, Ordog G, Wasserberger J, ed. Ellenhorn’s medical toxicology: diagnosis and treatment of human poisoning. 2nd ed. Baltimore, MD: Williams and Wilkins, 1997;240-243.